Introduction
Each year, over 10 million children die, 4 million of these in the first four weeks of life (the neonatal period). In this same period after birth, the majority of the world's 0.5 million maternal deaths also occur. The World Health Report 2005 calls for new momentum to address and improve maternal, neonatal and child health.
Meeting the Millennium Development Goal for child survival (MDG 4) requires a two-thirds reduction in death rates for children under the age of 5 by 2015. This target will not be met without substantial reductions in neonatal mortality, since neonatal deaths comprise almost 40 per cent of under 5 child deaths. The MDG 5 targets for maternal health include a three-quarters reduction in the risk of maternal death. However, progress towards this goal is slow.
Simple community-based approaches could reduce neonatal deaths by up to one third, and avert over half of child deaths. However, to save more maternal lives, and to achieve greater reductions in neonatal deaths, skilled care is required at and after childbirth. Currently coverage of such skilled care is low: over half of neonatal deaths occur at home with no contact with the health care system, and over 60 million women deliver without skilled care each year.
Africa and South Asia together account for two-thirds of maternal and neonatal deaths, but the least progress in increasing coverage of skilled care has been made in these regions, especially for the poor.
Current position
The MDGs for maternal and child health will only be met if major progress is made in scaling up coverage of key interventions around the time of birth and in the early postpartum/postnatal period – when risk of death is greatest and current coverage of care at its lowest. At the current rate of progress (two per cent per year) fewer than 50 per cent of women in sub-Saharan Africa will be delivering with a skilled attendant in 2015.
Moreover, national averages hide much lower coverage for the poor. These gaps in care continue while global policy swings between community-based and facility-based, skilled care. In addition, maternal and child health advocates have tended to compete for resources and neither have been investing in interventions that specifically address newborn survival.
